Clinical Features And Correlation Factors Of Autonomic Failure In Parkinson's Disease

Background Parkinson's Disease(PD)is a common disease in elderly, Which is characterized by the movement disorders ,such as tremor, rigidity and bradykinesia. Besides the core motor features of PD, other disorders such as gastro-intestinal dysfunction, postural hypotension, urinary, genital, sleep problems and pain contribute to the alteration of patient's quality of life. Frequency and clinical importance of autonomic failure in PD are discussed controversially.Objective To investigate the clinical features and correlation factors of autonomic failure in PD.Methods 71 definitely diagnosed PD patients in Neurology Department of our hospital were assessed from Apr 2004 to Oct 2005 .They were divided into 2 groups (Tremor type\Rigidity type ) according to the main movement disorders ,into normal PD group and early-onset PD group (EOPD)by theage of onset. According to the frequence of autonomic nerve system symptoms(ANS), 4 groups(Non- ANS\ Mild ANS \Moderate ANS \Severe ANS) were divided into. According to the course of disease and modified Hoehn-Yahr grade they were divided into the other two 3 groups (=2years\2~5years \=5years and 1-1.5 grade\2~2.5 grade\3 grade). UPDRS(Unified Parkinson's Disease Rating Scale) III and modified Hoehn-Yahr (H-Y) grade were performed on them by an identical neurologist. All of the data were analyzed by SPSS 11.5 for windows.Results Among the 71 patients, 40 male and 31 female,average age was 60.2±12.8 years old, average course of disease was 56.0±46.6 months, 49(33 male and 16 female) with ANS,the total percentage was 69.0%.Constipation was the most frequent ANS in PD,the occurrence rate was 43.7%, followed by dribbling , bladder dysfunction, hyperhidrosis and postural hypotension . The percentage of male patients with ANS was 82.5%,of female was 51.6% .There was significant difference between them(P<0.05).15 patients with ANS in 19 of Rigidity type group ,which was significantly higher than the Tremor type group (P<0.05).There were 18 EOPD patients, 12 of which with ANS.The occurrence rate had no significant difference with normal PD patients(P>0.05).16 PD patients with ANS in 26 whose course of disease less than 2 years, 19 with ANS in 30 whose course of disease from 2 to 5 years,and 14 with ANS in 15 more than 5 years,there were significant difference among them( p<0.05) . There were 50.0% PD patients with ANS whose H-Y grade was 1-1.5, 68.0% whose H-Y grade was 2-2.5 and 80.0% whose H-Y grade was =3,all of them had no significant difference(P>0.05). UPDRSIII of Non- ANS group was 17.68+8.33, Mild ANS group was 21.47±8.80, Moderate ANS group was 26.75±9.62, Severe ANS group21.30±8.40, Moderate ANS group scores were significant higher than Non-ANS group( p<0.05) ,there were no significant difference among the other groups(P>0.05). Conclusions: Autonomic failure in PD is important and common, male and those patients whose core motor fetures are rigidity are more often involved in.The longer course of disease ,the more frenquent ANS happens.